Perioperative, Operating Room and Surgical Nursing Commons^™

Improving The Coordination Of Care For Periprocedural Antithrombotic Medication Management In Patients Undergoing Elective Surgery, Joyce Larson

Doctor of Nursing Practice Scholarly Projects

Background: Arranging periprocedural antithrombotic medication (ATM) management is a frequently encountered complex clinical challenge. Often, there is limited time between the pre-admission clinic visit and the surgical date to coordinate ATM management and communicate the plan to the patient. This increases the risk of perioperative adverse events, case delays and cancellations, and is a patient safety concern. A quality improvement project was undertaken to address improving ATM periprocedural care coordination for patients taking ATM undergoing elective surgery. A review of the literature found clinical decision support system (CDSS) alerts to be an effective strategy. The aim of the project was …

Evaluating Pre-Anesthesia Telehealth Visit Outcomes In Cardiac Surgery Patients At A Tertiary-Level, Private, Academic Hospital, Ann Pan

Doctoral Projects

Telehealth is a dynamic, growing field in healthcare. Research has alluded to the potential of telemedicine in the pre-anesthesia area. With infection risk concerns brought to the forefront of healthcare due to the COVID pandemic, telemedicine offers an alternative evaluation method. Telehealth extends care to patients who otherwise would not have access to more comprehensive pre-anesthetic care and surveillance. Although studies show telemedicine's potential and positive effects, institutions have not extended virtual visits for all cardiac surgery pre-anesthesia patients. This retrospective evaluation study aimed to assess the impacts of telehealth on cardiac surgery pre-anesthesia assessments in a tertiary-level, private, academic …

In A Bind: Effect Of Abdominal Binding On Postoperative Pain In Abdominal Surgery Patients, Mattison Edinger-Vanatta

The Downtown Review

This evidence-based project seeks to answer the question, in patients who have undergone abdominal surgery, what is the effect of abdominal binders on postoperative pain? A literature review was conducted and ultimately, five peer-reviewed articles, comprised of three randomized controlled trials and two systematic reviews, were selected to answer this question. Each article studied the effect of abdominal binders using a “binder” and a “non-binder” group in patients who had undergone various types of open abdominal surgeries, including gynecological cancer excisions, cesarean deliveries, midline laparotomies, hernia repairs, and more. Each study used the visual analogue scale to assess patient pain …

Improving Patient Outcomes One Warm Patient At A Time, Lindsey King, Marcus Austin Robison, Julie Bonom Dnp, Michael Godbold Md

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Patient Temperature measurement postoperatively reveals that hypothermia occurs in surgical patients 25-90% of the time. Unintended perioperative hypothermia can be linked to many negative patient outcomes such as increased incidence of surgical site infection (SSI), delayed wound healing and increased length of hospital stay, to mention a few. Any single or combination of the aforementioned issues can eventually lead to an increase in patient morbidity and mortality. The purpose of this proposed quality practice improvement project is to increase the compliance of hypothermia prevention strategies, specifically forced air warming, at the implementation site. The targeted practice improvement is aimed at …

Anesthesia-To-Post Anesthesia Care Unit Handoff Standardization, Cassie Lee Bivens, Mark Timothy Cresap, Steven Michael Halcomb, Maureen Essie Taylor

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

The exchange of medical information from one medical professional to another is known as the handoff. Communication errors during the transition period of handoffs can lead to medication errors, delays in care, high stress within the work environment, and increased burnout of the nursing staff. Approximately 1,744 deaths and a total of $1.7 billion in malpractice costs were related to healthcare communication failures from 2012 to 2017. One of the areas of the hospital where effective handoffs are critically important, given the high frequency, is in the post-anesthesia care unit (PACU). Major organizations such as the Joint Commission, the …

Quality Improvement: Education And Implementation Of Proper Narcotic Handling Practices By Nurse Anesthetists, Shelby Stevenson, Anne Hendershott, Alexis Asprah

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Medication errors are estimated to occur once in every 150-300 surgeries (Wahr et al., 2017, p. 36). Unsafe injection practices can lead to increased morbidity and mortality, diminish the overall quality of life for patients, and contribute to substantial increases in healthcare costs. A large majority of unsafe injection practices are caused by a lack of education or mistaken beliefs regarding safe injection practices. Educational reinforcement of safe narcotic handling techniques has significant potential to increase the appropriate use of narcotic syringes among nurse anesthesia providers. The long-standing impact of this project could lead to a reduced number of ‘never …

Dexmedetomidine To Reduce Ponv, Amanda Johnson Srna, Joshua Lawrence Srna, Staci Martinez Srna, Taylor Mayberry Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative nausea and vomiting (PONV) contribute to patient dissatisfaction, discomfort, adverse outcomes, and increased healthcare costs. Despite current protocols that aim to reduce PONV by prevention/antiemetic administration, PONV continues to be a common manifestation in many postoperative patients (Elvir-Lazo et al., 2020). This scoping review aimed to analyze available research on the efficacy of dexmedetomidine to reduce perioperative opioid requirements and PONV.

Methods Synthesis of this scoping review began with a systematic approach to search databases and identify eligibility criteria articles. Of the 21 articles that met criteria, a synthesis table was formed to visualize the qualitative (smoking status, …

Dnp Final Report: Physical Activity In Bariatric Surgery Patients: An Evidence-Based Quality Improvement Project, Amber Buehler

DNP Final Reports

Background: Research evidence supports that increasing physical activity has been shown to reduce weight and prevent weight regain after bariatric surgery. There is currently no specific exercise recommendation or program at the Center for Metabolic and Weight Loss Surgery at Dallas.

Objective: To implement an evidence-based project surrounding physical activity to reduce weight regain in patients 12 months post bariatric surgery.

Methods: The 12-week program will consist of 3 times weekly 1 hour virtual exercise classes led by the Nurse Practitioner and/or Nurse. Patients will be screened for current physical activity via survey using the IPAQ at the beginning and …

Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna Mccleskey Bsn, Rn, Srna, Landon Mcdonald Msn, Rn, Cnl, Tim Moore Bsn, Rn, Srna, Jamie Pitcock Bsn, Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.

Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy.

To Flash Or Not To Flash, Christy Overly

The Eleanor Mann School of Nursing Student Works

In 2015, healthcare-associated infection (HAI) prevalence survey found that there were an estimated 110,800 surgical site infections (SSIs) associated with inpatient surgeries in 2015. Consequently, instruments and implants sterilized by immediate use steam sterilization (IUSS) have been found to increase the patient’s risk for an SSIs. Due to these risks, the Joint Commission (TJC) determined that organizations should implement evidenced-based protocols to reduce IUSS use. A needs assessment revealed a gap in care in that the increasing SSI rates appeared to be correlated with the misuse of IUSS at the physician owned surgical hospital in Tulsa, Oklahoma. This Doctor of …

The Impact Of Psychological Interventions Given To Icu Patients To Help With Pain Management, Kelly Liu

Nursing | Senior Theses

Pain management among the critically ill population is a significant issue in the intensive care setting. Whether the pain is acute or chronic, nurses tend to be the first-hand responders to help with pain management in the intensive care unit (ICU). With barriers ranging from patients’ inability to verbalize pain to nurses’ experience with obstacles to assessment such as sedation, confusion, or other concerns, pain management is a serious issue. Although pharmacological interventions such as opioids and analgesics help with pain control, in this thesis, we will focus on the impact of nonpharmacological and psychological nursing interventions and how it …

Nonpharmacological Interventions As An Adjunct Therapy For The Treatment Of Elderly Patients With Postoperative Delirium, Lorenzo Garcia

Nursing | Senior Theses

Background: Postoperative delirium is an iatrogenic disease that largely affects older surgical patients. Current treatment relies mostly on pharmacological management. However, this poses a problem due to the age-related changes in elders on drug metabolism. Other comorbidities increase chances of onset of postoperative delirium, and the possibility of unresolved cases. This leads to prolonged hospital stays, decreased quality of life, and overall poorer outcomes in these individuals.

Objective: The purpose of this literature review and proposal is to examine the use of non-pharmacological therapy as an adjunct treatment to improve outcomes in elderly patients diagnosed with postoperative delirium. Non-pharmacological interventions …

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five years. …

Interventional Radiology Procedures Without Sedation: The Nurse Experience, Catherine De Leon

Dissertations

Background: Many IR procedures offer a less invasive and economical alternative to some open or laparoscopic surgeries. Patients undergoing a procedure without moderate sedation are awake, alert, with heightened sensory perceptions, and vulnerable to their surroundings. There is a gap in the current body of literature relating to the IR nurse’s experience of caring for patients during procedures without the use of moderate sedation.

Purpose/Aims: The purpose of this study was to explore the lived experience of Interventional Radiology (IR) nurses caring for conscious patients undergoing a procedure without the use of sedation. This phenomenological study aimed to describe the …

Operating Room Nurses Sleep Health: An Evidence-Based Practice Sleep Health Education Project, Gabriella M. Castignoli

DNP Projects

Background: "Sleep Health" is a new Healthy People 2023 priority due to notable poor sleep health across the nation, with more than 25% of U.S. adults reporting insufficient sleep. Adequate sleep is necessary to work effectively and safely, with operating room (OR) nurses at high risk for inadequate sleep due to atypical work schedules.

Purpose: This project aims to establish the importance of sleep health for OR nurses at a community-based hospital and improve sleep health perception and sleep health through sleep health education with staff.

Methods: The IOWA model for evidence-based practice and quality improvement tools, Plan-Do-Study-Act, and the …

Improving Patient Discharge In The Ambulatory Surgical Setting Utilizing A Preoperative Educational Video, Leeann Kluth

The Eleanor Mann School of Nursing Student Works

Background: Use of ambulatory surgery centers providing outpatient surgical procedures has grown due to medical advances, short stays that reduce costs, and convenience for the patient. However, due to the reduced time between diagnosis and surgery, there is a decreased amount of time available for education and discharge teaching. Historically, discharge education is provided after surgery in written form while the effects of anesthesia and pain medication impair a patient’s ability to retain information. This leads to increased reports of uncontrolled pain, poor comprehension, and higher rates of adverse events due to poor comprehension of discharge orders.

Methods: The development …

Pain Management In Postoperative Pediatric Craniotomy Patients: A Scoping Review, Jessica M. Hiltenbrand Bsn, Rn, Sydney A. Scarbrough Bsn, Rn, Kaitlyn E. Shirley Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose/Background The pediatric craniotomy procedure is a complex and painful procedure that requires adequate pain management and frequent neurological assessments. Generally, evidence for pediatric pain management is severely lacking in research, and evidence for pediatric craniotomy patients is lacking even further. This scoping review aims to collect, condense, and review the current data in order to fuel future studies to establish more data, protocols, and evidence-based recommendations for analgesia in the pediatric craniotomy patient population.

Methods The studies selected were peer-reviewed, published in a medical or nursing journal, included study ages 0-21 years, or provided evidence on pediatric analgesia. Sources …

Comparing The Effectiveness Of Perioperative Ketorolac To Opioids: A Scoping Review, Kruze T. Vanderford Bsn, Ccrn, Srna, Abbie E. Walter Bsn, Ccrn, Srna, Anastasiya V. Woodard Bsn, Ccrn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Abstract Purpose/Background Opioids are commonly administered in the perioperative period to manage surgical pain. However, the ongoing opioid epidemic in the United States makes it necessary to evaluate other modalities of pain management that do not cause respiratory depression, nausea, vomiting and addiction. Ketorolac is a nonsteroidal anti-inflammatory drug that can manage pain safely and effectively. This scoping review examines the available literature on the effectiveness and feasibility of using ketorolac to minimize perioperative opioid use.

Methods A comprehensive literature review was performed between October 2020 and September 2021 utilizing five scholarly databases: GoogleScholar ™, PubMed, Ovid, Cochrane Library, and …

Effectiveness Of Perioperative Ketamine Vs. Opioid Analgesia On Extubation Time And Total Perioperative Opioid Requirement, Robert H. Gray Srna, Sarah S. Hardesty Srna, Heidi E. Higginbotham Srna, Charles A. Hoyt Ii, Srna, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Opioid analgesics are a primary source of pain control in the perioperative patient. However, all opioids decrease ventilatory drive secondary to mu2 receptor agonism in the brainstem. Ventilatory depression delays extubation after mechanical ventilation in post-operative patients, thus increasing the risk of complications such as ventilator-associated pneumonia and barotrauma. Non-opioid analgesics such as ketamine have been considered for use in order to reduce this risk. Ketamine is a noncompetitive N-methyl-D-aspartate receptor-antagonizing sedative that bears analgesic properties while preserving respiratory drive. Research suggests that ketamine provides effective perioperative pain control and decreases postoperative extubation time when given alone or with …

Development And Psychometric Evaluation Of A Questionnaire For Measuring Distraction Due To Mobile Phone Use In Operating Rooms, Mehdi Hasanshahi, Mahnaz Rakhshan, Armin Fereidouni, Seyed Alireza Moayedi, Camellia Torabizadeh

Journal of Perioperative Nursing

Aim: Use of mobile phones in health care centres can distract care providers and consequently disrupt the care procedure and risk patient safety. This study aims to develop and evaluate the psychometric properties of a questionnaire for measuring distraction caused by mobile phone use in operating rooms.

Sample and setting: 208 operating room nurses and doctors from five hospitals affiliated to Shiraz University of Medical Sciences participated in the study.

Method: This methodological study was conducted in two stages. In stage one, through a review of relevant texts, articles and books, the different dimensions of distraction as caused by mobile …